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HomeMy WebLinkAboutBLD2005-00648 PERMIT APPLICA B Review 0648 •UILDING N Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00648 Received Date: 10/7/2005 SITE ADDRESS: 120 W EUGENE ST PORT HADLOCK, 98339 OWNER: DONALD J BARROWS PHONE: CONNIE A BARROWS 120 W EUGENE ST PORT HADLOCK WA 983399659 IRONDALE SUBDIVISION: Block: 87 Lot: 16-24 PARCEL NUMBER: 961808701 Section: 34 Township: 30 N Range: 01 W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2006 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOt 120 GAL A/G PROPANE TANK, GAS INSERT AND GAS PIPING TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: CODE EDITION: 2003 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: CONST TYPE: OTHER: GARAGE: SHORELINE: CONST TYPE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $49.00 KAS 10/07/05 77087 Total: $49.00 0 • PROPANEIPELLET/WOOD STOVE & TANK INSTALLATION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD05-00648 Received Date 10/7/2005 SITE ADDRESS: 120 W EUGENE ST Issue Date 10/7/2005 PORT HADLOCK, 98339 APPLICANT: SUNSHINE PROPANE PHONE: (3601 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 16-24 SUBDIVISION: IRONDALE Block: 87 Lot: PARCEL NUMBER: 961808701 Section: 34 Township: 30N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2006 OWNER, DONALD J BARROWS PHONE: if different: CONNIE A BARROWS 120 W EUGENE ST PORT HADLOCK WA 983399659 PROJECT DESCRIPTION: 120 GAL A/G PROPANE TANK, GAS INSERT AND GAS PIPING THIS PERMIT IS VALID FOR ONE YEAR AND IS NOT RENEWABLE. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 10/07/2006. REQUIRED INSPECTIONS: Tank/Line/Appliance: /A.rEcr,,,e_ 1.rut=: f' 4i7PL:A/Cc OK iC)I131a5 FinalApproval: '7'176 BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. Office Hours 9:00 a.m. -4:30 p.m. HOT LINE AVAILABLE 24 HOURS A DAY I:\F BLD Permit_Propane.rpt 10/29/19C. Oct 07 05 03: 14p Le 1 -3�-385-5875 p. 2 ill SITE VISIT REPORT (PLOT PLAN) JOB _ gAQ412e0.. S DATE : qf2/0 6— CONTACT: ADDRESS _ PHONE #: DIRECTIONS FAX #: Email PLANNER: W. Eo cruE ibry:ftdC r51) 70 cQo' Le iw A etx-:-.11. �a�'" J Wee.: '1��G [p l;CA(ISYY`� 4 / 1 (ACzei p gQ P(v ,�^',�� Gro V - srb / i0 f Iz Pitc.N comp shi,�cic 200.9 USA: yD' L4,0,0E2. itJO STir_44110L.E PEA, 70 ch 4 vEI/ G ")s� ON L, OU • i o& JEFFERSON NTY ` `'A ` DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Towns •,Wricto[L91137E_e _ 360/379-4450 • 360/379-4451 Fa)1 q�, O� www.co.jefferson.wa.us/commdevei•1• , �nt Master Permit Application ��T - M Project Description(include separate sheets as necessary): A l p 9"-A-4--) Tax Parcel q / Property r Number: -/ to / $0 e 70( Size: (acres/square feet) Site Address and/or Directions to Property: / ) /) /) . p/, ,ii Property Owner(s)of Record: C2 /J/7 c e_. 6/q Telephone: . l- - _ ol- ` Fax: 4. .� email: Mailing Address: . Applicant/Agent(if different from owner): rZ 4.-1 Telephone: s Fax: email: Mailing Address: S 0 r —e( .e. a, ( (t)c ,P33,- What kind of Permit?(Check each box that applies) ❑ Building ❑ Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit ❑ Conditional Use[C(a),C(d),or CI** ❑ Single Family 0 Discretionary"D"or Unnamed Use Classification ❑ Garage Attached/Detached 0 Special Use(Essential Public Facilities)** ❑ Manufactured Home 0 Boundary Line Adjustment ❑ Modular 0 Short Plat'"* 0 Commercial* 0 Binding Site Plan** 0 Change of Use 0 Long Plat** ❑Address i:i Road Approach 0 Planned Rural Residential Development(PRRD)/Amendments** 0&ropane ❑ Plat Vacation/Alteration** wed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions** 0 Stormwater Management ❑ Shoreline\Management Substantial Development** ❑Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance ❑Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment 0 Forest Practices Act/Release of Six-Year Moratorium *May require a Pre-Application Conference **Requires a Pre-Application Conference Please identify any other local, state or federal permits required for this proposal, if known: DESIGN ION OF AGENT •I he by-tesi ct as my n matt rs relatin licatio - ermit(s). TUBE By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of his,her or it's knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application fg review and any(IFWL uired later inspections.Access and right of entry to this property shall be r quested and shall occur only during regular business hours. Signature: (A- r vt/i rj- .A. ' Date: O— I q—The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the Iiii "Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been Issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-tra fixable responsibil!tx for hexing to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Va Signature: l-L,L N' Date: 9- I q-co G:\PemutCenta\FORMS\DRD FORMS Permit Application 7-8-04.doc • OWNER BUILDER STATEMENT • The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL RACTOR OR MANUFACTAL OME INSTALLER: PHONE: FAX: � )'J 6-z_s_A___. ( ) 3(f_s-5757 ( ) MAILING ADDRESS: /OBS3 jZ& ( EMAIL: CONTRACTOR'S LICENSE I WAINS NUMBER: Lstih f ac.L-.7 077 OP NUMBER ARCHITECT/ENGINEER: /V ` PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New 0 Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: 0 Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well 0 Two Party Type of Heat: Proposed: ❑ Public Total: Name of System: If this Is a Commercial Project you must answer the following: Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No If this Is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: ❑ Underground Tank 0 Above ground Tank Size of Propane Tank: /)n G' 15(Heat Stove ❑ Cook Stove ❑ Woodstove Fireplace Insert 0 Hot Water Tank 0 Pellet Stove X"Other -o P ¢ s his appliance being Installed in a Manufact red/Mobile Home? Yes / No v When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines,tank location and size,distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. Square Footage For Office Use Only Current Proposed Amount Main Floor Consistency Review: 5 D 2ND Floor Base fee: , ro r'0 r y q u. Do 3 Floor Additional Section: Mezzanine: Plan Check fee: . 1 Heated Basement at v \1)\ State Surcharge fee: Unheated Basemen D Pot Water Review fee: Other Unheated 1 ' OCI — 7 2005 ' } 911/Rd Approach fee: Garage/Carport i TOTAL $ Decks _ '' _ .J Receipt Number q ' d'1 Other Cash/Check Number: .1 ESTIMATED COST(REQUIRED) Date: *Fair market value of all labor and materials foundation to finish 10 1 ©� Initials: a(4 SE ;:\PenmtCenter\FORMS\DRD FORMS\Master Puma Application 7-8-04.doc